Parent/Guardian details to be completed only where the applicant is 16 or 17 years old.

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1 POINTS BASED SYSTEM FORM (VAF9 JAN 2010) APPENDIX 8: TIER 4 (GENERAL) STUDENT SELF-ASSESSMENT This form is for use outside the UK only This form is provided free of charge. For official use only READ THIS FIRST This form must be completed in blue or black ink. Please ensure you submit all relevant, original documents as indicated in the sections. It is better to explain why you do not have a document than to submit a false document. Your application will be automatically refused and you may be banned from coming to the UK for 10 years if you use a false document, lie or withhold relevant information. You may also be banned if you have breached immigration laws in the UK. An applicant aged over 16 can choose to apply either as a Child (Student) or a (General) Student and meet the appropriate criteria. Please ensure you also complete the main Personal Details form. Part 1 About You 1.1 Given name(s) 1.2 Family name Part 2 Parent/Guardian details to be completed only where the applicant is 16 or 17 years old. Parent/Guardian Give your parent or guardian s given name >>>>>>>>>>> 2.2 Give your parent or guardian s family name 2.3 Give your parent or guardian s full contact address, including postal code. 2.4 Give details of your relationship to your guardian Parent/Guardian 2 (if applicable) 2.5 Give your parent or guardian s given name 2.6 Give your parent or guardian s family name 2.7 Give your parent or guardian s full contact address, including postal code. 2.8 Give details of your relationship to your guardian 01

2 2.9 Give the full address of where you will be residing in the UK including the postal code. If this is not known and your sponsor is arranging your accommodation give the contact details of the person doing this, and/or the temporary address you will use on arrival You must provide a letter of consent to this application from your parent(s) or legal guardian. Put a cross (X) in the box to confirm you have done so (See the Tier 4 Policy Guidance for details of what this must contain) Will you be travelling to the UK alone? Put a cross in the relevant box Yes - Go to Part 3 No - Complete Question Provide full details of up to two adults who will accompany you Full name Full name Address including postal code Address including postal code Telephone No. Telephone No. Nationality Nationality Passport No Passport No Exact relationship to you Exact relationship to you Part 3 Tier 4 Sponsor (Education Provider) contact details 3.1 Give the full name of your Tier 4 Sponsor 3.2 Give your Tier 4 Sponsor s Licence Number >>>>>>>>>> 3.3 Give the full address of your Tier 4 Sponsor including postal code 02

3 Part 4 Course details 4.1 Give the title of your course of study >>>>>>>>>>>>>>> 4.2 Give the start and end dates for your course of study >>> From 4.3 Give the full address of your primary site of study, including postal code. See the Tier 4 Policy Guidance for an explanation of primary site of study. To Part 5 Attributes You should refer to the Immigration Rules and the Tier 4 Policy Guidance. You require 30 points from this part, or your application will be refused. 5.1 Confirmation of Acceptance for Studies (CAS) Select to confirm you are claiming points for having a valid Confirmation >>> of Acceptance for Studies, Put a cross (x) in the box 5.2 What is your Confirmation of Acceptance >>>>>>> for Studies Number? 5.3 Confirm which of the following options applies. Put a cross (x) in the relevant box Undertaking a post as a Sabbatical Officer Studying - Go to Question 5.4 Go to Question 5.10 Undertaking a foundation course as a Postgraduate Doctor or Dentist - Go to Question You must send all of the original certificate(s) of qualification and/or original transcripts of results that are >>>>>>>> listed in the CAS. Put a cross (X) in the box to confirm you have done so 5.5 Have you been assessed by your sponsor by other means, for example references, by progress on a continuing course of study, as part of a study abroad programme, by your sponsor s internal test, a portfolio of artwork, or other means (state which)? (Please do not submit this) Put a cross (X) in the relevant box. Yes - Say how you have been assessed in the space below then Go to Question 5.6 No - Go to Question 5.6 English Language course 5.6 Are you coming to the UK to study an English language qualification that is CEFR level B2 or above or to study English as a foreign language? Put a cross (X) in the relevant box. Yes - Go to Question 5.7 No - Go to Question Have you been assessed by means of an academic/professional reference? If so you must provide evidence of each of the references listed in the Confirmation of Acceptance for Studies. Put a cross (X) in the relevant box to indicate what you have provided. The original reference Go to Part 6 Not Applicable A copy of the reference together with an original letter from your sponsor confirming it is a true copy. Go to Part 6 ATAS certificate 5.8 Are you required to obtain permission from the Academic Technology Approval Scheme (ATAS)? (See the Tier 4 Policy Guidance for the circumstances when this is required) Put a cross (X) in the relevant box. Yes - Go to Question 5.9 No - Go to Part Put a cross (X) in the box to confirm you have provided the original of your Academic Technology Approval >>>>>>> Scheme (ATAS) clearance certificate. Then Go to Part 6 03

4 Sabbatical Officer 5.10 Put a cross (X) in the box to confirm you will be a Sabbatical Officer. Then Go to Part 6 We will use the Confirmation >> of Acceptance for Studies from your sponsor, provided in Question 5.1, as evidence. Postgraduate Doctor or Dentist 5.11 If you intend to be a Postgraduate Doctor or Dentist we will use the CAS from your sponsor provided in >>>>>>>>> Question 5.1. You must also provide an original letter from the relevant Postgraduate Dean. Put a cross (X) in the box to confirm you have done so You must send us all of the original certificate(s) and/or original transcripts of results of your United Kingdom >>>> qualification in Medicine or Dentistry that are listed in the CAS. Put a cross (X) in the box to confirm you have done so. Part 6 Maintenance (Funds) You must have a minimum level of funds to cover your course fees and support yourself. You should refer to the Immigration Rules and the Tier 4 Policy Guidance. You need 10 points from this part, or your application will be refused. 6.1 How much are the fees for your course of study? The figure should be the same as in the CAS which will be used as the specified evidence for this. If you will be studying at a Residential Independent School this will include course fees and boarding or lodging fees. If you are beginning a new course give the fees for the first year of the course, or for the entire course, if it less than one year s duration. If you are a applying for a further period of leave to continue an existing course, give the course fees that you still need to pay to the end of the current academic year, if you are part way through the year; or for the next academic year if you will continue on your course at the start of the next academic year. If you have no course fees to pay put 0.00 in the box. If this will be part of a study abroad programme give any fees you will be required to pay to the UK education provider for the first year of your course, or for the entire course, if it is less than one year s duration. If you have no fees to pay the UK education provider put 0.00 in the box. 6.2 Have any of your course fees been paid? Put a cross (X) in the relevant box. Yes - Paid to UK Education Provider. Enter the amount in the box below then - Go to Question 6.3 Yes - Paid to Overseas Higher Education Institution (Zero fee on CAS) - Go to Question 6.3 No - Go to Question Put a cross (X) in the relevant box to show what document has been provided as evidence of payment. Shown in the CAS An official, original receipt 6.4 Put a cross (X) in the box to confirm you have sufficient funds to cover all course fees due for payment. >>>>>>>>>>> 6.5 Put a cross (X) in the relevant box to confirm whether you are making an initial application or an extension application. Initial application Go to Question 6.6 Further period of study following a course of less than six months (No reduced maintenance level) Go to Question 6.6 Further period of study following a course completed more than four months ago (No reduced maintenance level) Go to Question 6.6 Further period of study following a course of six months or more within your last period of leave and completed less than four months ago; or to complete an existing course of study where you have studied at least six months of the course and been studying within the last four months; or if you are applying to continue in Tier 4 as a sabbatical officer or as a Postgraduate Doctor or Dentist where you completed a course that was at least six months duration within your last period of leave and this leave finished within the last four months. Go to Question Initial application Put a cross (X) in the relevant box to confirm your primary site of study. See the Tier 4 Policy Guidance for an explanation of the Inner London Boroughs and how to assess your primary site of study. Inside the Inner London Boroughs Go to Question You must have 800 per month to cover >>>>>>>>>>>>> maintenance in the UK (up to a maximum of 9 months). Outside the Inner London Boroughs Go to Question You must have 600 per month to cover maintenance in the UK (up to a maximum of 9 months). 04

5 6.9 Extension application (following a course of six months or more and completed less than four months ago) Put a cross (X) in the relevant box to confirm your primary site of study. See the Tier 4 Policy Guidance for an explanation of the Inner London Boroughs and how to assess your primary site of study. Inside the Inner London Boroughs Go to Question You must have 800 per month to cover >>>>>>>>>>>>> maintenance in the UK (up to a maximum of 2 months) You must have 600 per month to cover maintenance in the UK (up to a maximum of 2 months) Have any of your accommodation fees been paid to your sponsor? Put a cross (X) in the relevant box. Yes - Paid to UK Education Provider. Enter the amount in the box below then - Go to Question 6.13 Outside the Inner London Boroughs Go to Question 6.11 Yes - Paid to Overseas Higher Education Institution Go to Question 6.13 No - Go to Question Put a cross (X) in the relevant box to show what document has been provided as evidence of payment. Shown in the CAS An official, original receipt 6.14 Showing funds Do you receive support from a financial sponsor that meets the UK Border Agency definition of a financial sponsor? (See Tier 4 Policy Guidance for definitions) Put a cross (X) in the relevant box Yes - Go to Question 6.15 No - Go to Question Put a cross (X) in the relevant box to confirm what evidence of financial sponsorship you have provided. An original letter to confirm the financial sponsorship from You are receiving official financial sponsorship from your Tier 4 an official financial sponsor or Government sponsor. licensed sponsor (e.g. a scholarship or bursary), and details of the financial sponsorship are included in the CAS Complete the box(es) to indicate how much the official financial sponsor or Government sponsor is paying towards your expenses. For Course fees For Maintenance 6.17 Do you have any fees and maintenance still due for payment? Put a cross (X) in the relevant box. No - No money due, no evidence needed Yes - Complete the boxes below Go to Part 7 Course fees >>>>>>>>>>>>>>>>> Maintenance >>>>>>>>>>>>>>>>> Total >>>>>>>>>>>>>>>>>>>>>>> 6.18 Do you have money in your own name? Put a cross (X) in the relevant box. Yes - Go to question 6.20 No - Go to question 6.19 Have money in own and parent / legal guardians bank account. - Go to question Put a cross (X) to confirm that you have provided a letter from your parent or legal guardian. >>>>>>>>>>>>>>>>>>>> Put a cross (X) to confirm that you have provided one of the following pieces of evidence of the relationship. Birth Certificate naming Student and Parent(s) Certificate of adoption naming the student and the adoptive parent(s) Court document naming the student and the legal guardian(s) 05

6 6.20 Put a cross (X) in the relevant boxes to indicate what evidence of funds has been supplied to cover all maintenance and fees which you still need to pay. All documents must be originals. The funds must have been in your (or your parent or legal guardian s) bank account/building society account for 28 days prior to the date of your application. Personal bank or building society statements Letter from a bank or building society confirming the funds or the agreement of a loan Savings or building society pass books Letter from a regulated financial institution confirming funds or the agreement of a loan. Translations Any documents that have to be submitted in support of points claimed, which are not in English or Welsh must be accompanied by a full translation that can be independently verified by the UK Border Agency. The original translation must contain confirmation from the translator that it is an accurate translation of the original document the date of the translation the translator s full name and signature, and the translator s contact details. Part 7 Summary Sheet Please complete the summary sheet below, listing the points you have claimed and the documentation provided. You must provide the required evidence as specified in this application form and the Tier 4 Policy Guidance. All documents must be originals unless otherwise stated. Failure to submit required evidence is likely to lead to refusal of the application. Points Scoring Area Points Claimed Documents Provided (please list) Possession of a CAS (30 points) Maintenance (Funds) (10 points) Total I confirm I have completed the separate Personal Details form and accept the contents of the declaration. Applicant s signature Date Parent/Legal Guardian s signature (If applicant is 16 or 17 years old) Date YOU MUST SUBMIT A PAPER COPY OF THIS APPENDIX WITH YOUR SUPPORTING DOCUMENTS. ENSURE YOU ALSO COMPLETE THE PERSONAL DETAILS FORM EITHER ON PAPER OR ON LINE. YOU SHOULD SIGN THE DECLARATION AND SUBMIT THIS WITH YOUR OTHER DOCUMENTS. 06

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